多重抗藥性淋病的診斷治療與衍生的倫理問題

Diagnosis, Therapy, and Ethical Issues in the Treatment of Multidrug Resistant Neisseria Gonorrhoeae

淋病屬第三類法定傳染病，大部分皆在基層診所診斷治療。過去對penicillin類及quinolone抗藥性問題不斷浮現，在東亞地區quinolone抗藥性的比例達80%以上，2006年美國疾病管制局不建議使用fluoroquinolone治療淋病。在台灣ceftriaxone目前可有效根除泌尿生殖道淋病感染。本文報告二位ciprofloxacin抗藥性淋病尿道炎的年輕男性診斷與治療過程，也討論性伴侶的治療與衍生的倫理議題和法律爭議。

Gonorrhea, usually diagnosed and treated in primary care clinics, is classified as a third-category notifiable infectious diseases which requires mandatory reporting to the Taiwan Centers for Disease Control. In East Asia, as well as in Taiwan, up to 80% of gonorrheal cases are quinolone-resistant. Due to the increasing number of cases of penicillin-resistant or quinolone-resistant gonorrhea, the United States Centers for Disease Control and Prevention stopped suggesting treating gonorrhea with fluoroquinolone in 2006. In this paper, we report the cases of two young male adults with ciprofloxacin-resistant gonorrheal urethritis. One of them was initially treated with fluoroquinolone and was a treatment failure. Changing the antibiotic to ceftriaxone eventually resulted in treatment success. The other case was lost to follow-up after the diagnosis was confirmed and treatment with ceftriaxone was started. Although expedited treatment is a very important strategy for treating gonorrhea, physicians in primary care clinics in Taiwan still encounter dilemmas due to legal and ethical concerns when employing this strategy.